MANOSHI: Community Health Solution in Bangladesh Maternal, neonatal and under-five children health service indicators in slums of Narayanganj City Corporation- A baseline survey 2012

Increase in the number of inhabitants in urban slums has become a challenge on the health system of Bangladesh for tackling maternal and under-five child morbidity and mortality. To address this engaging issue, BRAC implemented a community based essential maternal, neonatal and child health (MNCH)-care service package programme, called MANOSHI in 2007. The programme targeted the slums in six city corporations of Bangladesh through the community health workers (CHWs) called BRAC Shasthya Kormis (SK) (Ahmed et al. 2010; Afsana and Rohde 2011; Afsana 2010). For reducing illness and deaths of mothers, newborn and children, the MANOSHI programme scaled up its activities in the slums of Narayanganj City Corporation (NCC) during May 2011. The study aimed to generate baseline data on maternal and underfive child health needs in terms of prevailing knowledge, prevalence of complications, healthcare service utilisation and referral network in the slums of NCC for assessing the impact of the programme. This was, a cross-sectional study conducted during June-July 2012. A total of 47 slums were selected randomly from the intervention area. Ten slums from Narsinghdi Sadar Municipality (NSM) were selected as comparison. Two groups of married women with reproductive age between 15-49 years were selected in this study from both areas. The first group (Group 1) consisted of mothers with five different types of pregnancy outcomes preceding one year of interview. The second group (Group 2) consisted of mothers each with a child aged 12-59 months. The total sample size was 2400. A pre-structured questionnaire was used for data collection.

The average age of women was 25 years, the median age at first marriage was 16-17 years and age at first conception was 17-18 years in both slums. The proportion of under-five child death was higher in the slums of comparison area compared to the slums in the intervention area (6.5% vs. 10.7%; P=0.000). About 12% women in the intervention area experienced abortion in their lifetime. Although, only 5% women had gone through one or more menstruation regulation (MR) process in both areas, more respondents in the comparison slums had complications after MR compared to respondents in the intervention slums (29.6% vs. 75%; P=0.000). More than half of the respondents who had complications after MR, sought treatment from an MBBS doctor (66.7% vs. 52.1%). Contraceptive prevalence rate (CRP) was higher among the respondents in the intervention slums compared to the comparison slums (68.9% vs. 59.8%; P=0.000). However, use of modern contraceptive methods by married adolescent girls was similar in both areas (68.4% vs. 58.1%; P=0.164). In addition, very few men and women used permanent FP methods. In the intervention slums, 43% women received four or more ANC visits from medically trained providers1 (MTPs) compared to 20% women in the comparison slums. Only 3.0% respondents from intervention slums received four or more ANC visit by BRAC SK. It was found that receiving four or more ANCs from the MTP was significantly associated with the socioeconomic status, literacy and educational status in the.........................